August 11, 2010

By Rich Bernstein

Visits to the emergency room continue to escalate in the U.S., according to a new study. Researchers concluded that the reason for the increase is that more people are on Medicaid, and that those on Medicaid experience a lack of access to primary care services.

The study found that an estimated 94.9 million visits were made to U.S. emergency departments in 1997, and an estimated 116.8 million visits were made in 2007. The sharp increase in visits to the ER amounted to twice the rate that researchers expected, based solely on population growth. Visit rates for those with private insurance and those on Medicare showed no significant change.

Researchers also predicted that the ER visitation rate may have increased further outside of the study window. The recession hit hard in 2008 and 2009, causing 5.8 million Americans to become uninsured, with another 5.4 million enrolling in Medicaid or SCHIP (State Children’s Health Insurance Program).

Those statistics point toward a further lack of access to primary care, which means the emergency room is essentially the only location for many people to receive care – even if they cannot necessarily afford it. As a rule, when providing services, American emergency departments do not consider a patient’s level of insurance coverage or ability to pay. These are not factors that can lead to a denial of services.

The increasing trend to use the ER as a “safety net,” however, could eventually lead this facet of the healthcare system to undermine itself, according to researchers. The number of ERs utilized as a safety net greatly increased from 1997 (1,770) to 2007 (2,489). The definition of a safety-net facility is one that receives 30% of its total visits from individuals with Medicaid, or 30% of its visits from uninsured individuals. Or, if these two categories make up at least 40% of total visits, the facility also qualifies.

Let’s take a more in-depth look at the statistics from the study, which was conducted by University of California, San Francisco researchers. It also appears in JAMA (Journal of the American Medical Association). All of the following relate to increases between 1997 and 2007…

• Visits to the ER increased from a rate of 352.8 to 390.5 per 1,000 persons.
• Total ER visits increased 23.1 percent.
• ER visits by those with Medicaid increased from 693.9 to 947.2 per 1,000 enrollees.
• Median emergency department wait times to see a physician increased from 22 minutes to 33 minutes.
• The total number of ERs dropped 5 percent.

In conclusion, the researchers stated that a comprehensive study of the differential access to primary care by insurance type (Medicaid, etc.) is needed to better understand healthcare utilization patterns. This would enable the healthcare system to develop more effective strategies for reducing pressure on the safety net and improving care.

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